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Navy & Marine Corps Medical News 


Feb 4, 2000 

The Navy Bureau of Medicine and Surgery distributes Navy 
and Marine Corps Medical News (MEDNEWS) to Sailors and 
Marines, their families, civilian employees and retired Navy 
and Marine Corps families . To achieve maximum medical 
information distribution, your command is highly encouraged 
to distribute MEDNEWS to ALL HANDS electronically, include 
MEDNEWS in command newspapers, newsletters and radio and TV 
news programs. 

Stories in MEDNEWS use these abbreviations after a Navy 

medical professional' s name to show affiliation : MC - 
Medical Corps (physician) ; DC - Dental Corps; NC - Nurse 
Corps; MSC - Medical Service Corps (clinicians, researchers 
and administrative managers) . Hospital Corpsmen (HM) and 
Dental Technician (DT) designators are placed in front of 
their names. 


Contents for this week's MEDNEWS: 

Headline: Shelton ready to tackle TRICARE issues 

Headline: Naples shows "Can Do" spirit supporting Fleet ship 

Headline: Military liaison group tells the TRICARE story 

Headline: Keep your smile for life 

Headline: Anthrax question and answer 

Headline : TRICARE question and answer 

Headline: Healthwatch: Flu season brings double trouble this year 


Headline: Shelton ready to tackle TRICARE issues 

By Staff Sgt . Kathleen T. Rhem, USA, American Forces Press 


WASHINGTON — DoD has made huge strides in quality-of- 
life issues, but healthcare for service members and their 
families still needs serious work, the nation 's top military 
officer said Jan. 31. 

"To have implemented TRICARE worldwide in five years with 
its 8.3 million beneficiaries is quite an accomplishment," 
Army Gen. Henry Shelton, chairman of the Joint Chiefs of 
Staff, said in opening remarks at the three-day 2000 TRICARE 
Conference here. "A tremendous amount has been achieved, 
but I'm sure you'll all agree with me that we still have a 
long way to go. " 

Shelton told his audiencB of some 400 civilian and 
military healthcare providers and administrators that 
healthcare is one of DoD's "big four" quality— of— life issues 
- the building blocks of a quality volunteer force. The 
other three are pay and compensation, retirement benefits, 
and housing. 

He cited the 4 . 8 percent pay raise, pay table reform and 
repeal of the Redux retirement plan in the fiscal 2000 
budget as examples of the defense leadership 's commitment to 
recruit and retain a quality force. Also, Defense Secretary 
William Cohen in January announced a major initiative to 
eliminate out— of— pocket housing costs within five years. 

"This year we've got to address healthcare, " Shelton 
said. "The bottom line is that our service members and 
their families must be able to count on their healthcare 
system. Our fighting men and women on the front lines of 
freedom need to know that their families are being taken 
care of. " 

He told the group that thanks to e-mail, today's deployed 
troops know almost immediately if there is a problem with 
healthcare at home. "While they are doing their job taking 
care of the nation 's defense, they expect us to provide an 
effective, user-friendly healthcare system, " he said. 

Overall, TRICARE beneficiaries may say they're satisfied 
with the healthcare they receive, but many complain about 
the process of getting that care, Shelton said. "Every time 
I talk to them, one of their most frequent complaints is 
. . . with the process it takes to finally get the care they 
need, " he said. 

"To the health system's credit, once our men and women 
and families receive care, few of them complain about the 
quality of care or the attitude of the healthcare 
providers, " he told the conference attendees . "This is a 
bright spot in the system, and when it works it is the 
result of the hard work that you all do. " 

Shelton said many frustrations can be traced to poor 
customer relations and bad business practices. TRICARE 's 
regional structure works against consistency in such 
"common-sense areas" as appointments, claims and enrollment, 
he noted. 

"As many of you know, TRICARE requires that members re- 
enroll every time they change regions, something that occurs 
frequently as our service members and their families must 
pick up and move every two to three years, " he said. 
"This adds to their stress and frustration, and oftentimes, 
their workload. " 

Another concern is that there are differences in benefits 
between those stationed stateside and those stationed 
overseas. "These challenges require our urgent attention, " 
Shelton said. He noted that Dr. Sue Bailey, assistant 
secretary of defense for health affairs, addressed the Joint 
Chiefs in January and laid out a plan and a schedule to fix 
these issues. But that's still not enough, he said. 

"We ask our service members to be ready to serve any 

time, anywhere. They expect no less from their healthcare 
system, " he said. "If a service member can't count on 
TRICARE when it 's needed, then when the time comes to re- 
enlist, the answer might just be 'no. ' In short, TRICARE 
can't be just an insurance agency; it must be much more. " 

Shelton said he has testified before the Senate Armed 
Services Committee that improving medical care is a top DoD 
priority in the fiscal 2001 defense budget. He said 
improvements should focus on several areas: 

— Fully funding and placing more emphasis on the Defense Health 
Program. Shelton said the program has been underfunded for 
several years. "We are encouraging unit leadership, from the 
senior flag officers to the platoon leaders, to understand, get 
involved and become advocates for the military health system, " 
he said. "This is clearly a program that deserves command 
attention and support." 

— Ensuring every installation has a TRICARE hot line. 

" (This is) not to bypass the chain of command, but to bring 
medical care issues to the attention of the appropriate 
people at the appropriate levels, " Shelton said. 

— Increasing retirees' benefits. Important first steps 
would be to increase pharmacy benefits and to fully fund and 
expand TRICARE Senior Prime. "Our retirees deserve the 
healthcare that they have earned and DoD committed to, " he 

— Establishing a healthcare network to meet the needs of all 
beneficiaries. Start this with automatic enrollment of all 
active duty members and their families, Shelton said. He 
said beneficiaries should have quick, easy access to case 
managers, and fair and timely claim payments. All enrollees 
need to know who their primary case manager is and how to 
contact them. "I applaud your recent initiative to make 
sure that the patient knows his doctor by name, " he said. 
"This is just plain good medicine. " 

— Changing "navigation" to make the system as customer- 
focused and easy to use as possible . "Many service members ' 
attitudes toward TRICARE stem from their experiences on the 
telephone, " Shelton said. "Our service members and their 
families should not be forced to wait on the phone and 
listen to recordings for 20 minutes just to secure an 
appointment." He said another irritant, the claims process, 
should be "invisible to the active duty members and 
simplified for all others. " 

The chairman told the group his staff will work actively 
with DoD's new Defense Medical Oversight Committee, which 
aims to address current irritants and future benefits of the 
military healthcare system. 

He urged managers to test their own systems. "For those 
who are military healthcare members, try not wearing your 
uniform one day — you 've got my permission — and walk into 
the TRICARE offices you 're responsible for to see how you 're 
treated, " he said. "If you find things not to your liking, 
fix them. 

"Remember, if it 's hard for you, imagine what it 's like 

for the young, inexperienced mother of two whose husband is 
deployed to Bosnia or Kosovo or any of the other garden 
spots our troops are deployed to, " Shelton said. 

He told the group they should act as advocates for their 
beneficiaries, not adversaries. "You work on behalf of our 
warriors and their families . They need your support, and I 
know that you are committed to helping them, " he said. "It 
is my goal that a future chairman a few years from now can 
come before you and say with conviction, 'Our healthcare 
system is a success and better than any other in the world, 
bar none . ' " 

For more information about TRICARE, visit the web site at 
http: //www. 


Headline: Naples shows "Can Do" spirit supporting Fleet 

By Lt. j.g. Jon Spiers, USN, USS Spruance 

USS SPRUANCE (AT SEA) — After a relaxing holiday period, 
the "Quiet Warriors" of USS Spruance (DD 963) started out 
the new century with a Mediterranean Sea deployment. 

As Spruance entered the fourth month of its cruise, the 
ship's Medical Department continued the excellent medical 
readiness of everyone onboard. But before that medical 
readiness could be achieved, the ship needed the help of 
U.S. Naval Hospital Naples. 

The week before Spruance and the USS John F. Kennedy (CV 
67) Battle Group were to deploy from Mayport, Fla., and 
Norfolk, Va., Hurricane Floyd disrupted pre-deployment 
planning including halting medical physicals and other 
preventive care. So the ship got underway still needing to 
complete some of the crew's medical work. 

But as far as medical preparation was concerned, the 
hurricane simply highlighted the forward thinking of the 
Spruance medical team and the flexibility of Navy Medical 
facilities. Chief Hospital Corpsman (SW) Bob Martel and his 
Spruance corpsmen had a backup plan for the crew's medical 
needs . 

As soon as the ship's visit to Naples, Italy, was 
confirmed, its corpsmen contacted the Fleet Liaison Officer 
at Naval Hospital Naples, Hospital Corpsman First Class (SW) 
Mike Lechette, to arrange appointments and finish the 
medical care the hurricane had curtailed. 

Martel said, "The dental clinic staff, Branch Medical 
Clinic at Capodichino and the Naval hospital staff, 
especially Petty Officer Lechette, were all fantastic at 
scheduling appointments ahead of time and getting last 
minute appointments and providing supplies as well . " 

A few days later when the Spruance arrived in Naples, the 
ship's corpsmen were busy ensuring that all medical 
examinations and procedures would occur as planned. 
Hospital Corpsmen Third Class Frances Breitenfeld and Roger 
Watson, the Spruance' s junior Corpsmen, kept pushing 

physical examination paperwork, performing initial screening 
tests and collecting samples for the hospital 's lab work. 

Early coordination with the hospital and action by the 
ship's corpsmen permitted 109 appointments . Additionally, 
the dental clinic provided emergency care for some of 
Spruance' s Sailors. 

Getting medical work done for one-third of a destroyer's 
crew was not only a medical headache. Hospital coordination 
was so meticulous, a bus was provided to transport the 
Sailors back and forth from the pier to the hospital in 
Naples to ensure everyone arrived on time for their 
appointments . 

In a "Can Do" fashion, hospital staff extended their 
working hours to expedite getting Spruance back to sea. 
According to Lechette, that included providing medical work 
for Spruance Sailors in addition to supporting regularly 
scheduled appointments. 

Another example of the hospital team's full— service was 
providing pharmacy "care packages " to the Spruance Medical 
Department, which were timely supplements to the medical 
supplies of a forward deployed ship. 

Spruance shoved off to continue its Mediterranean cruise 
with a medical readiness profile considerably improved. 
Bravo Zulu to U.S. Naval Hospital Naples for its excellent 
support . 


Headline: Military liaison group tells the TRICARE story 
By Earl W. Hicks, Bureau of Medicine and Surgery 

AURORA, Col. - Before going to sea, a Sailor or Marine 
wants to know that medical care for the family is in place 
and that loved ones will not have difficulty getting that 
care. Ensuring that "know how" information is available 
to active duty naval personnel and their families is the job 
of the Military Liaison Directorate (MLD) of the TRICARE 
Management Activity. 

MLD, originally founded to educate Health Benefits 
Advisors during the Civilian Health and Medical Program of 
the Uniformed Services or CHAMPUS era, now spreads TRICARE 
information with a variety of training techniques. 

In addition to eight TRICARE training courses scheduled 
at Aurora each year, MLD teams also give TRICARE training 
presentations to medical personnel at Military Treatment 
Facilities and to line organizations around the world. 
"We recently completed a week-long training program at 
U.S. Naval Hospital Yokusaka, Japan, and at Keesler Air 
Force Base, Miss.," said Hospital Corpsman First Class 
Douglas N. Elsesser (FMF) of the Navy/Marine Corps liaison 
office in Aurora. "Attendees learned about TRICARE Prime 
and Standard, selected benefits and active duty special 
considerations such as enrolling at each new command, among 
other topics." 

The MLD office in Aurora is joint— service and comprises 

Navy, Army, Air Force and Coast Guard personnel . Its 
mission is to teach Department of Defense uniformed 
personnel, medical department personnel, retirees and their 
families around the world about TRICARE. 

MLD teams travel more than 100, 000 miles each year giving 
3-day and one-week courses and briefings, according to Lt . 
Cmdr. Michael Anaya, MSC, of the Navy /Marine Corps liaison 

Understanding the program is not the problem, " but 
becoming familiar with the process takes more training, 
according to Anaya. 

The MLD is also planning for future enhancements to its 
TRICARE messages, according to Elsesser. Some of the 
enhancements include taking more training and messages to 
Fleet ships before deployment . Elsesser said presentations 
to active duty naval personnel and their families before the 
ship gets underway can alleviate a lot of concerns about 
medical care. 

Another enhancement will be complementing current 
communications methods with a Health Benefits Advisors email 
network to ensure new policies and guidance gets to the 
advisors immediately. 

"If beneficiaries can understand the process, it seems 
likely they will have greater comfort with lower frustration 
and out of pocket expenses, " said Anaya . "Patient 
satisfaction and understanding is very important to all 
within TRICARE. " 

Lt . Cmdr. Michael Anaya, MSC, of the Navy/Marine Corps 
liaison office contributed to this story. 


Headline: Keep your smile for life 
From Bureau of Medicine and Surgery 

WASHINGTON — Are you afraid of the dental needle? Do 
you enjoy keeping your mouth open for a long time? Do you 
cringe at the sound of a dentist ' s drill? It is possible to 
avoid these experiences for the rest of your life simply by 
controlling your dental health. 

What usually brings us in contact with the needle and 
drill is dental cavities and gum disease caused by bacteria 
that live in our mouths. If the bacteria are allowed to 
multiply and grow in number, they destroy teeth and gums. 

Cavities or caries destroy tooth enamel . They occur when 
foods such as milk, soft drinks, raisins, cakes or candy 
containing sugars and starches are frequently left on the 
teeth. Bacteria that live in the mouth combine with the 
sugars and starches to make acids that over time destroy 
tooth enamel . 

Every time you eat food that contains sugars or starches 
your teeth are attacked by acid for 20 minutes or more. 

Gum disease is caused by plaque, a sticky film with 
bacteria that constantly forms on the teeth. These bacteria 
create toxins that can damage the gums. In the early stage 

of gum disease, called gingivitis, the gums can become red, 
swollen and bleed easily. 

At this stage, the disease is still reversible and can 
usually be eliminated by daily brushing and flossing. Gum 
disease is usually painless. If left untreated it can lead 
to inflammation of the gums with loss of the bone that 
surrounds and supports the teeth. This gum deterioration 
affects three out of four adults in a lifetime and is the 
main cause of tooth loss in adults. 

The best way to remove plaque from tooth surfaces is to 
brush and clean between your teeth twice a day with a soft- 
bristled brush. The size and shape of your brush should fit 
your mouth, allowing you to reach all areas easily. 

Use toothpaste that contains fluoride, which helps 
protect your teeth from decay. Cleaning between the teeth 
with floss or interdental cleaners removes plaque from 
between the teeth and other areas where the toothbrush can't 
reach. Cleaning between the teeth is essential in 
preventing gum disease. 

A dental check-up will ensure early detection of 
problems. The dentist may suggest using plastic material 
sealants that bond to the grooves of the chewing surfaces of 
back teeth. The sealants will act as a barrier protecting 
enamel from plaque and acids that cause decay. 

The Navy's dental treatment community rates the dental 
health of naval personnel as class 1,2, 3 or 4. Class 1 
means you do not require any dental treatment . You are 
dentally healthy . This is the class that the Navy dental 
department wants all Naval personnel to have. 

About 70 percent of Sailors and Marines are in the other 
dental classes . 

Class 2 means you require dental care, but there is a low 
risk of a dental emergency within the next 12 months. You 
may need a small filling, a cleaning or a crown. You should 
schedule an appointment right away. 

If you fall in dental class 3 or 4, you should visit your 
Naval Dental Center as soon as possible. Class 3 is someone 
who requires urgent care and there is a high risk that you 
will have a dental emergency within the next twelve months. 
You may need one or more large fillings treated, a root 
canal or an extraction of one or more teeth (most often the 
wisdom teeth) . 

Dental Class 4 is given to patients who have not had an 
exam within the last 12 months or more and their dental 
condition is unknown. 

The Navy Dental Corps has a goal of ensuring that Naval 
forces are dentally ready for deployment . 

"The Sailors and Marines that serve this country deserve 
nothing but the very best dental care, they deserve dental 
health, " said Rear Adm. Jerry Johnson, DC, chief of the 
Navy Dental Corps. 

By taking care of your teeth, eating a balanced diet and 
visiting your dentist regularly, you can have healthy teeth 
and an attractive smile for the rest of your life! 


Headline: Anthrax question and answer 
From Bureau of Medicine and Surgery 

Question: What areas are considered high— threat for 
exposure to anthrax? 

Answer: The Joint Staff has designated Korea, Bahrain, 
Jordan, Kuwait, Oman, Saudi Arabia, Qatar, the United Arab 
Emirates (UAE) , Yemen, and Israel (10 countries and 
surrounding waters) as high-threat areas. 

For more information about anthrax visit the web site at 
http: //www. anthrax, . 


Headline: TRICARE question and answer 
From Bureau of Medicine and Surgery 

Question: If I enroll in TRICARE Prime does that mean 
that my whole family has to enroll? 

Answer: Not all family members are required to enroll in 
TRICARE Prime. Depending on your specific situation and 
needs, it may be best, for example, for a spouse to be in 
TRICARE Prime, and a student son or daughter, to use Extra 
or Standard. Contact your TRICARE Service Center for advice. 

For more information visit the TRICARE web site at 
http: //www. tricare . . 


Headline: Healthwatch: Flu season brings double trouble this 


By Tanya Brown, Bureau of Medicine and Surgery 

WASHINGTON — The flu bug made its rounds early this 
year, filling up emergency rooms and overworking hospital 
staffs while leaving a trail of high fevers and achy 
muscles . 

But don't think that the close of January brought an end 
to this flu pandemic. 

"J expect to have another wave [of the flu] in a week or 
two, " said Capt . Michael Krentz, MC, Department Head at 
Naval Medical Center Portsmouth. 

There are generally two waves of the flu, according to 
Krentz . The largest wave, which hit the country in early 
January is slowly ending, but the second wave has yet to 

Fortunately, it won't tear through the country with the 
same a fury as its predecessor. 

"We won't see as many cases," said Krentz. 
"Eventually, so many folk would have had the flu that there 
won't be enough new people to contract it, and it will die 
out . " 

That^s a welcome relief for the thousands of people who 
have suffered through the symptoms brought on by the virus. 
But for the small percentage that has yet to feel the wrath 
of the nasty bug, there's still enough time to get the flu 
shot . 

"The key to prevention is the influenza vaccine, " said 
Cmdr. Dennis Rowe, MC, family physician at Naval Hospital 
Pensacola. "The vaccine is a good, effective vaccine." 

Although the vaccine is not 100 percent effective, Rowe 
said that taking the vaccine reduces the risk of contracting 
the flu. "And even if you do get the flu, you won't have 
as bad a course than if you didn't get the vaccine," he 

Rowe advises people at high risk - heart problems, 
diabetes, asthma and premature infants - to get vaccinated. 

Influenza, commonly called the "flu, " is a viral 
infection that affects the respiratory tract . Unlike other 
viral respiratory infections like the common cold, the flu 
causes a more severe illness, but does not last as long and 
like all viral infections, it does not respond to 
antibiotics . 

Two new flu drugs Relenza and Tamiflu are the latest 
development in combating the flu, but they are not a cure- 

According to a report by the Food and Drug 
Administration, flu drugs do not prevent people from 
catching influenza. The report comes after several public 
inquiries that suggested doctors were prescribing flu drugs 
for other ailments. 

"Prescribers should be aware that patients with severe 
influenza— like illness, especially those who have chronic 
medical conditions, may have significant bacterial 
infections ...instead of influenza, " the report said. 

Relenza and Tamiflu only work within the first 48 hours 
of having the flu symptoms. 

If the initial preventive measure of taking the flu 
vaccine is not an option, then there is always a secondary 
measure. Because the flu is primarily transmitted through 
the air it doesn't hurt to minimize its spread. 

"Covering your mouth when you cough or sneeze and good 
handwashing techniques are invaluable, " said Rowe. 
"Overall, prevention is the key. " 


Comments about and ideas for MEDNEWS are welcome . Story 
submissions are encouraged. Contact MEDNEWS editor. Earl W. 
Hicks, at email:; Telephone 202/762— 
3223, (DSN) 762-3223, or fax 202/762-3224.